Jugular Fossa Lesions

Kenan I. Arnautović, Ossama Al-Mefty
2002 Contemporary Neurosurgery  
Learning Objectives: After reading this article, the participant should be able to: 1. Describe the basic anatomy of the jugular fossa and foramen. 2. Describe the differential diagnosis ofjugular fossa lesions. 3. Recall basic preoperative diagnostics and operative approaches to jugular fossa lesions. lar foramen. It lodges the jugular bulb, which continues into the jugular vein inferiorly (Fig. 1) . In the neurosurgical literature, and even in extensive anatomic studies, both the jugular
more » ... th the jugular foramen and the jugular fossa often are referred to by the term "jugular foramen." This use of the term may be the result either of simple error or the user's wish to provide a broader anatomic description of the area, and this confusion may be the underlying reason for the current lack of agreement regarding the internal anatomic organization of "the jugular foramen." Regardless of the reason for this mix-up, the jugular foramen and the jugular fossa are two distinct anatomic formations, although they are intimately related. The treatment of jugular fossa lesions has been revolutionized by the development of modern diagnostic modalities, refinement of microsurgical techniques, publication of microsurgical anatomic studies, development of skull base approaches, advances in neuroanesthesia and intraoperative neurophysiologic monitoring, and careful multidisciplinary perioperative planning. These lesions now are treated with radical resection, and the rates of permanent surgical morbidities or mortalities are low. Anatomic Considerations The jugular foramen is a skull opening, or gap, that connects the posterior cranial fossa and the jugular fossa. It is formed by the jugular incisuras in the temporal and occipital bones. It lies in an oblique position, from the lateral aspect posteriorly toward the medial aspect anteriorly. Classically, it is described as subdivided by a fibrous or bony bridge (the intrajugular septum) into two parts, which serve as a passage for Cranial Nerve IX and the inferior petrosal sinus (pars nervina or nervosa) and for Cranial Nerves X and XI and the jugular vein. More recent anatomic studies have disputed this theory of the anatomic organization of the jugular foramen/ and there still is no single accepted view of its anatomy. The jugular fossa, located at the inferior aspect (inferior surface) of the petrous part of the temporal bone, is a deep depression, the size of which varies from skull to skull. It communicates with the posterior cranial fossa via the jugu- Differential Diagnosis The most cornmon differential diagnoses of lesions in the jugular fossa include, in descending order of frequency, glomus jugulare tumors/ neurinoma of the lower cranial nerves (Cranial Nerves IX-XI), and meningiomas (Figs. 2-4 ). The broader differential diagnosis of jugular fossa tumors may include chordoma/ chondrosarcoma, primary cholesteatoma, plasmacytoma/ epidermoid tumors, choroid plexus papilloma, chondroma, temporal bone carcinoma, salivary gland tumors, aneurysm, metastases, and cerebellar hemangioblastoma. The preoperative radiologic diagnosis and differential diagnosis are important when jugular fossa lesions are the subject, because preoperative management and operative planning may differ considerably depending on the type ==========----------. ------of lesion in question, e.g., planning preoperative embolization for glomus jugulare tumors, or determining how much of the tumor involves bone if it is a meningioma. = --------Category: Tumor, Anatomy
doi:10.1097/00029679-200208150-00001 fatcat:swgve5qc7fhcfailwl7d4mgaiy